PT  - JOURNAL ARTICLE
AU  - Ngo, Hà
AU  - Maarsingh, Otto
AU  - Slottje, Pauline
AU  - Blanker, Marco
AU  - Groenhof, Feikje
AU  - Bont, Jettie
AU  - van Vugt, Vincent
TI  - Inappropriate antivertiginous drug prescribing for patients with vestibular symptoms in primary care
AID  - 10.1370/afm.22.s1.5004
DP  - 2023 Nov 01
TA  - The Annals of Family Medicine
PG  - 5004
VI  - 21
IP  - Supplement 3
4099  - http://www.annfammed.org/content/21/Supplement_3/5004.short
4100  - http://www.annfammed.org/content/21/Supplement_3/5004.full
SO  - Ann Fam Med2023 Nov 01; 21
AB  - Context: There is insufficient evidence that antivertiginous drugs are effective in patients with vestibular symptoms. However, betahistine is one of the most frequently prescribed off-label drugs. The role of family physicians in these inappropriate drug prescriptions is still unclear.Objective: This study aimed to evaluate the frequency of (long-term) antivertiginous drug prescriptions in primary care. We also aimed to identify factors associated with long-term prescriptions.Study design and Analysis: We performed a retrospective observational cohort study. We used descriptive statistics to determine baseline characteristics and to calculate the prevalence and incidence of prescriptions. We performed a multivariable logistic regression analysis to identify factors associated with long-term prescriptions.Setting: We used routine primary care data from more than 1.2 million patients registered at 269 primary care practices throughout the Netherlands within the period March 2018 to February 2021.Population studied: We included adult patients with vestibular symptoms and/or prescriptions for antivertiginous drugs using International Classification for Primary Care (ICPC) codes and Anatomical Therapeutic Chemical codes.Intervention/Instrument: Not applicable.Outcome measures: Primary outcome was the prevalence of prescriptions for antivertiginous drugs. Secondary outcomes were the incidence of prescriptions, prevalence of long-term prescriptions, and factors associated with long-term prescriptions.Results: We included 72.429 patients with vestibular ICPC codes, 9.2% of these patients had at least one prescription for antivertiginous drugs. 2.700 patients received prescriptions without a vestibular ICPC code. Of all patients with prescriptions, 36% received long-term prescriptions. Older age, Ménière’s disease, and practices with 7.501-10.000 registered patients were associated with a higher rate of longterm prescriptions, while patients with vestibular neuritis, benign paroxysmal positional vertigo and a symptom diagnosis of lightheadedness were less likely to receive one. Patients registered at practices in extremely urbanized areas were also less likely to receive long-term prescriptions.Conclusions: Inappropriate antivertiginous drug prescriptions, including long-term prescriptions, are still common in Dutch primary care. Our findings indicate that management of patients with vestibular symptoms by family physicians can be further improved.